Enda Kenny (Mayo, Fine Gael)
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Yesterday saw the publication of the Harding Clark report into medical practices at Our Lady of Lourdes Hospital, Drogheda, where, for more than 20 years, practices conducted by a doctor were not questioned and a number of procedures were carried out which deprived women of the opportunity to have further children, which has caused them untold distress and anxiety. Most upsettingly, while some people came forward with information during this time, it was not acted on. Effectively, there was a wall of silence and denial about the events at Our Lady of Lourdes Hospital in respect of the extremely grave concerns expressed about the number of peripartum hysterectomies carried out over a particular period. The report makes for quite shocking reading and arising from it, I wish to ask the Taoiseach a number of questions.

First, can the Taoiseach indicate the status of any Garda inquiry into what the report describes as a deliberate, careful and systematic removal of key historical records, together with master cards and patients' charts? Second, while the removal of these records hampered the inquiry, it also caused considerable stress to the women involved. It is also quite sinister that JudgeHarding Clark reported that three forced criminal entries to her premises took place while the inquiry was under way. Can the Taoiseach indicate to the House whether the Government has made any decision, in principle or otherwise, about the establishment of a redress board for the women affected by Dr. Neary's actions?

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time has concluded.

Enda Kenny (Mayo, Fine Gael)
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Finally, does the Taoiseach now accept that we need comprehensive whistleblowers' legislation, such as that proposed by Deputy Rabbitte and the Labour Party some time ago, which would provide protection for staff members in any organisation who bring attention to wrongdoing? The Taoiseach and the Government are aware that in many sectors of Irish society, telephone calls to journalists have led to discoveries. This has occurred in the financial services sector and a concerned citizen came to me with information regarding PPARS. However, in the case of Dr. Neary, no one came forward for 20 years. The Government should consider it to be both appropriate and a legislative priority to enact comprehensive whistleblowers' legislation to protect concerned citizens with a legitimate concern which should be investigated. Perhaps the Taoiseach will respond to these three points.

Bertie Ahern (Dublin Central, Fianna Fail)
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I repeat statements I made yesterday by thanking the chairperson, Judge Maureen Harding Clark and the inquiry team for their work in recent years in conducting the inquiry and in the preparation of a very comprehensive report. She acknowledged the co-operation given to the inquiry during its work, particularly that of Patient Focus. I acknowledge the contribution of Patient Focus in its work with my colleagues and with the Tánaiste. The Tánaiste will meet its representatives later today.

I also express my deepest regret and apologise to these women and their families for what happened. On behalf of the Government, we are very sorry and deeply regret what happened. As I stated yesterday, we are all equally appalled.

As for the three questions raised by Deputy Kenny, the Garda conducted an investigation into this matter previously. However, given the report's publication and findings, it will be sent to the Garda which will carefully study it. It is also important that the Garda should speak to Judge Maureen Harding Clark because her investigations narrowed down the possibilities. In particular, she identified some items found on some of the files in question, which I understand would be very helpful to the Garda. Hence, the Garda will undoubtedly so do.

On the issue of redress, the Tánaiste will, as promised, speak to Patient Focus. Obviously, the Government is aware that issues will arise in respect of compensation, culpability, etc. This issue will be addressed today and the Government will return to it. We have made no formal decisions.

Regarding whistleblowers' legislation, as I noted yesterday in respect of this particular case, while a matron raised the issue in the 1980s, her concerns were brushed aside. Subsequently, in 1998, midwives raised their concerns with the solicitor for the health board and the matter was taken up, which led to the current position and the publication of the report yesterday.

As I stated yesterday, after examining the Bill provided by the Labour Party previously, it was decided that the best way to achieve its aims was to insert provisions for a investigative system for whistleblowers into sectoral legislation. This has already been done in respect of three or four Acts and is based on experiences in other countries. When this issue was examined some years ago, only a few countries in the organised world had gone down this road. I understand two countries which did so have subsequently reversed their decision. Hence, it was considered that the best way to cater for whistleblowers was to insert the provisions into individual sectoral legislation. The Government is in favour of this approach and has included the requisite provisions in a number of Bills. Obviously, given this report's findings, the issue will arise again.

The proposed medical practitioners Bill, the proposed Health Information and Quality Authority Bill and the consultants' contract negotiations are all relevant matters which must now take account of, and are affected by, this report's findings.

Enda Kenny (Mayo, Fine Gael)
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It is entirely appropriate that Deputy Bertie Ahern, in his capacity as Taoiseach, should apologise to the women who were so seriously hurt, emotionally and physically, arising from these incidents.

I hope the Garda re-institutes its investigation. It is quite sinister for Judge Harding Clark to state that her premises was forcibly entered on three separate occasions during the course of this investigation.

In respect of the whistleblowers' legislation, it is not a situation where we must stumble from crisis to crisis and look at individual sectors retrospectively. There is merit in what the Labour Party proposed and despite the sector by sector approach, it deserves serious consideration.

Arising from the Neary case, the Government should look at the analysis by Judge Harding Clark of the failures of many of the bodies in the health service to be monitored and regulated properly, particularly where self-regulation of their own members occurs. I have commented previously that there is a strong case for a patient safety authority within the health area which would put patient safety at the centre of medical practice. There are such authorities in other areas of Irish life. Nobody has the legal authority, for instance, to close a public hospital, a private hospital, a public or private medical practice, a public or private dental practice, a private or public pharmacy practice or an alternative therapy clinic like the Carmody clinic. There is no authority that can close any of these. The Government should look again at the issue of a patient safety authority which would give vigorous oversight.

If the Minister for Arts, Sport and Tourism wishes to laugh at this, if that is his attitude to a serious and constructive proposal, then he should be ashamed of himself.

Liz McManus (Wicklow, Labour)
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Hear, hear.

Bernard Durkan (Kildare North, Fine Gael)
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And his colleague as well.

Bernard Allen (Cork North Central, Fine Gael)
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Did the Minister, Deputy McDowell, say it was a joke?

Michael McDowell (Dublin South East, Progressive Democrats)
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Deputy Allen does not know what we were talking about. He does not know what he is talking about either.

Enda Kenny (Mayo, Fine Gael)
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Maybe he is allied to Deputy McDowell.

John O'Donoghue (Kerry South, Fianna Fail)
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He is rambling.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Kenny, your time has concluded.

Enda Kenny (Mayo, Fine Gael)
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I do not know what the Deputy is talking about.

Deputies:

The gardaí know what they were talking about.

Enda Kenny (Mayo, Fine Gael)
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He, above anybody else, has been going on like a demented organ-grinder for the past month.

John O'Donoghue (Kerry South, Fianna Fail)
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Better than being the monkey.

Bernard Allen (Cork North Central, Fine Gael)
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The meat in the sandwich.

Enda Kenny (Mayo, Fine Gael)
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A patient safety authority is something that should be examined seriously by the Government. It would give vigorous and strong control over patients' safety.

Bertie Ahern (Dublin Central, Fianna Fail)
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I think I have answered most of the questions. On the regulatory bodies, all the professions in medicine and the related areas have their own regulatory bodies for the individuals in the professions concerned. The Medical Council, the Pharmaceutical Council and An Bord Altranais regulate the behaviour and standards of their staff.

There is no licensing authority for hospitals, either public or private. That is an issue that arises. I understand it is not simple to do but I accept it should be done. We never had such an authority. The procedure is voluntary and always has been, but it is an issue that arises.

I answered on the issue of putting into sectoral legislation the means whereby people may be able to give information.

The findings and recommendations will be of considerable benefit. As I stated yesterday, we completed the heads of the medical practitioners Bill a long time ago. These findings will be used to complete that Bill and bring forward the preparation of a new medical practitioners Bill.

There also has been considerable work done on the health information and quality authority Bill by the Department of Health and Children. Of course, as I mentioned, the current consultant contract negotiations have commenced and we can also take account of the findings and the recommendations in that regard. These issues will be followed up.

As I stated earlier, files were removed. I am not too sure there was a connection between the break-in in the judge's office but obviously these are matters that the Garda will look at. The full report, hopefully with consultation with the judge, would help to narrow down some of the issues that the Garda will be able to follow up from its earlier report.

Pat Rabbitte (Dublin South West, Labour)
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There are many questions that are not answered by the Taoiseach but obviously the single biggest question is, how this could have gone on for 24 years. While we certainly owe a great debt to the author of this report for the manner in which complex material is handled and the substantial and insightful recommendations that are made, the fact remains that were it not for the bravery and courage of a single midwife, Dr. Neary could still be mutilating women today. With all of the medical bodies, all of the self-regulation and the supervision of the Department of Health and Children etc., people outside will find it difficult to understand that this could have happened.

On the more than 24 years of what the author states was a truly shocking rate of unnecessary hysterectomies, the Taoiseach made a passing reference to the matron who protested in 1978 and who was dismissed "by gesture". It took 20 years — until 1998 — for a midwife, in the course of an interview with the legal representative of the health board about something else, to draw attention to this and it would appear from a first reading of the report that the health board acted promptly. However, Dr. Neary was allowed to select the nine cases that would be the subject of the peer review and the three obstetricians in Dublin found his conduct was flawless. That seems mind-boggling to the average citizen. Peer review is driven by data. No data was furnished by this man. He seemed to have the final say on matters like that. Nobody from the Institute of Obstetricians and Gynaecologists ever asked him why the normal data that ought to have been submitted was not submitted. When this midwife took action, the health board responded and a peer review was established, he was allowed to select the cases and three obstetricians stated it was okay.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Rabbitte's time has concluded.

Pat Rabbitte (Dublin South West, Labour)
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I am not at all clear on what the Taoiseach has stated. Take, for example, the Whistleblowers Protection Bill 1999 that his Government supported when I introduced it in the House in June 1999. If employees in those circumstances had statutory protection, surely this would have come to light earlier. It is almost beyond belief, leaving out the professional affinity between professional colleagues such as anaesthetists who apparently never brought this to the attention of the institute. Other health personnel would have done so if there had been statutory protection.

The Taoiseach stated he will deal with this on a sectoral basis. At the same time he has never explained why he reinstated my Bill to the Order Paper after the 2002 general election, and it is still on it. If he thinks it is not appropriate and ought to be superseded by sectoral legislation, why does he not take it off the Order Paper? He cannot have it both ways. He is stating, on the one hand, it is unsuitable. Every time something like this arises, the response is that the sector was not covered.

I presume this report will be the subject of a major debate in the House and will then be referred to committee where we will need to deal with some of the complexities in it because it is not a simple matter.

Bertie Ahern (Dublin Central, Fianna Fail)
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I will deal with the latter issue first. The meeting was not about whistleblowing but about another issue and the midwife raised this particular issue in that context. The whistleblower, which is not the correct title, raised it in the context of another issue and said the issue should be examined. It was examined and the solicitor raised the issue. After that the three obstetricians were appointed and the College of Obstetrics conducted at least two examinations of the standards. As the Deputy said, they gave a clean bill of health both to the individual and to the unit. The Deputy has used his own terms for that and I will not disagree. I cannot understand that either. This raises issues for the Medical Council, which it accepts. The Minister for Health and Children has raised the issues with the council and will meet its representatives. It also raises issues for the College of Obstetrics because three of its senior members examined the cases and procedures and believed that Dr. Neary was fine for practice, even though we now have the figures for his hospital and can compare them with similar hospitals. Issues, therefore, arise for the Medical Council and the College of Obstetrics and they must be followed through.

The provision of statute protection for whistleblowers, which is a different issue, on a sectoral basis might be a better and a more focused approach than dealing with the issue any other way. We have put this provision into the child protection and reporting Bills, a competition Bill, a health and safety bill and other legislation. It is not the case that we have failed to do this but it is not the point on this issue.

Pat Rabbitte (Dublin South West, Labour)
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I do not think the Taoiseach has read the report and I ask him, when he gets an opportunity away from his other pressures, that he might do so because that was a muddled reply, which was all over the place.

Even when the former Minister for Health and Children, Deputy Cowen, was written to, it took a year to get an acknowledgement. When a woman wrote about a second consultant in the same hospital to the Medical Council, the letter was lost. The report is littered with this kind of thing and the Taoiseach is entirely missing the point. If there had been whistleblower protection, a member or members of the health service staff would have brought this to light earlier.

I draw the Taoiseach's attention to a single conclusion on page 322 of the report, which states:

In making recommendations, we are aware that our inquiry has been uniquely confined to an examination of documents, practices and structures in Lourdes hospital maternity unit. It is, therefore, not clear whether this maternity unit was unique in its practices or whether similar practices and attitudes are found in any other peripheral hospital in the State.

What does that mean? What steps are being taken to explore the meaning of that particular, ominous paragraph?

I am not clear from the Taoiseach's contribution whether it is the intention of the Government to implement the recommendations of this report. Has the Minister for Health and Children had an opportunity to study it and bring proposals to Government? Her idea of incorporating elements of this into the common contract, if it is ever renegotiated, with consultants is good but other recommendations have been made and I am not clear from what the Taoiseach has said whether it is the attitude of the Government to implement them. It is an extraordinary saga that this could have gone on over 24 years and were it not for a particular midwife who blew the whistle, the doctor might still be doing it. There is no other way of misrepresenting what she did and it does not matter whether she was dealing with another matter.

I do not understand the Taoiseach's reply on the question of Patient Focus and its discussions with the Minister for Health and Children and so on. Will a suitable system of redress be put in place for the women who comprise that group and who were so disgracefully treated at the hands of our health services?

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte seeks to create a little confusion on this but I will try to be clear. The Government said it is a damning report and the findings and recommendations will be fully taken into account. The Minister for Health and Children will meet the hospital's board and the Medical Council. In so far as issues must be addressed by a number of regulatory bodies, they will be followed through and, in so far as some of these issue relate to other hospitals, they will also be followed through. My point, which I think the Deputy understands but which he is trying to confuse, is if somebody raised the issue — in this instance a midwife did — and it was brought to the highest source——

Pat Rabbitte (Dublin South West, Labour)
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The Taoiseach is missing the point.

Bertie Ahern (Dublin Central, Fianna Fail)
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No, the Deputy is missing the point. Three obstetricians from the College of Obstetrics were appointed to examine the issue and they concluded there was no difficulty.

Liz McManus (Wicklow, Labour)
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The health board did not accept that.

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte can hardly say nothing happened.

Pat Rabbitte (Dublin South West, Labour)
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They examined many cases directed by him.

Emmet Stagg (Kildare North, Labour)
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They were a disgrace.

Bertie Ahern (Dublin Central, Fianna Fail)
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That raises issues for the College of Obstetrics and the Medical Council.

Emmet Stagg (Kildare North, Labour)
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The three examiners should be examined.

Bernard Allen (Cork North Central, Fine Gael)
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It is a club.

Bertie Ahern (Dublin Central, Fianna Fail)
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The Minister for Health and Children has raised those points.

With regard to Patient Focus, I stated yesterday we promised we would discuss a number of issues with the group as soon as the report was completed. The group's representatives have made it clear the issue of redress will come up and the Minister for Health and Children will meet them and members of the hospital's board today. Meetings will also be held with the Medical Council and others.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The victims of the former consultant, Michael Neary, and others at Our Lady of Lourdes Hospital, Drogheda, have been vindicated by the report of Judge Maureen Harding Clark. These women were subject to a procedure that mutilated them so that they could not conceive again. Scores of women have been seriously hurt and are suffering as a result of their experience. It is very important that we should remember that none of them was told what would be done to them or had it properly explained. Many learned some time later from their spouses or partners or in an offhand way. Real and substantial issues need to be further addressed. What action is the Taoiseach and the Government prepared to take?

The Minister for Health and Children stated yesterday that the report confirms the appropriateness of actions being taken under the new medical practitioners Bill, the reform of the current consultant contract and the changes in management systems within hospitals. How will we, as accountable elected representatives, judge that? The heads of the medical practitioners Bill were agreed by Government as far back as 2004. Yesterday I asked the Taoiseach whether he would encourage or facilitate the release of the heads to all health spokespersons. The Taoiseach deftly ignored the question, but I will put it again. Will he now publish the heads of the Bill in order that all parties may see the pertinence of the Tánaiste's claim? The reform of the consultants' contract is overdue since 2002 and seems to be deadlocked. It has gone nowhere. Where does that contract and its renegotiation stand?

What action will the Garda take on the issue of the medical records that have been stolen? It has already investigated the issue, but will it now proactively pursue the issue to discover who was responsible for the removal of the files, not just in a single situation but in duplicate? Will the Government establish a redress board? There is no reason to dither on this issue. The report is comprehensive and the women involved have appealed for a redress board time and again. Patient Focus has made the same appeal. The appeal is supported by a significant body of elected Members of both the Dáil and the Seanad who have continually put the case in support of the Patient Focus argument for a redress board to be established. The Taoiseach should advise the House of the clear intent of Government in this regard.

Bertie Ahern (Dublin Central, Fianna Fail)
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Judge Harding Clark's report is enormously helpful in every way. It is the case that the women were not advised. As I said earlier, in fairness when these cases were brought to light, the health board followed up on them. It followed up on the information given to it by the midwife and when the three obstetric consultants examined the case. It did not accept that and engaged a consultant from Manchester who gave a different view. Therefore, it did follow up on the issues. However, what the Deputy has said is correct.

The heads of the Bill will be amended and published sometime between Easter and the summer period. The heads must now be amended based on the findings of this report, but they will be published in advance of the legislation. The Garda Síochána investigated the case previously but now has new information. It is a matter for the Garda to investigate it fully and no doubt it will and will carefully the report. I said I thought it would be useful for the Garda to consult with Judge Harding Clark because it seems — I have probably gone through more of the report than anybody else since its publication — that she has interesting information.

Compensation is an issue the Government will address. However, the Deputy will understand the hospital and the doctor are insured. Whatever arrangements are made, we must ensure that taxpayer does not carry everything. That issue will be discussed today with Patient Focus.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome the fact the Taoiseach said he has had the opportunity to study the report at least as much as any other Member. If that is the case, has he noted that while the report states that much has changed for the better in Our Lady of Lourdes Hospital in Drogheda, it also mentions some worrying facts? It criticises, for example, risk management among some consultants and says consultants use up too much of their time with private patients. Will the Taoiseach note that and discuss it with the Tánaiste and Minister for Health and Children?

The report states: "No elective major gynaecology operations are carried out as there are no dedicated gynaecology beds available for elective operations." What has the Taoiseach to say about this? It is clearly indicated in the report that theatres, staff and clinicians with the requisite skills are in place. The equipment is there, but operations of the type referred to by JudgeHarding Clark are not carried out because there are no dedicated gynaecology beds for elective surgery in that area. This is absurd in a hospital that provides the critical mass of the service to women throughout the north-east area. What is the Taoiseach going to do about this?

Did the Taoiseach note the comments yesterday from the solicitor for Patient Focus, which has done wonderful work with and on behalf of the women concerned, stating this will happen again because the culture has not been removed? We need to know what the Taoiseach and the Tánaiste are going to do to remove that culture so we may guarantee to women throughout the land that this can never happen again.

Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy said he has looked at the report. He will have noted the conclusion of Judge Harding Clark that the hospital had made major improvements and she felt it was a remote chance that such issues could recur. However, she highlighted other areas that needed to be put right. The Tánaiste will start addressing those issues in today's discussions with the board. Professor Drumm has already been looking at the issues in the north east. The number of consultants in the hospital has doubled and major improvements have been made. I have answered the question already.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What about the beds?

Bertie Ahern (Dublin Central, Fianna Fail)
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Professor Drumm is responsible for examining these things. The other issues raised will be discussed by the Tánaiste with the board. As I said earlier, the regulatory issues arising from this for the Medical Council, the College of Obstetrics and anybody else must be followed through.